《伤寒杂病论》心悸证治特色探赜

Exploration of the Syndrome and Therapeutic Characteristics of Palpitations Based on Treatise on Febrile and Miscellaneous Dis⁃eases

[目的]探析《伤寒杂病论》中仲景对心悸的治疗特色。[方法]通过对《伤寒杂病论》中心悸条文的系统研读,结合对其他古籍论述的学习,归纳总结《伤寒杂病论》中心悸证型分类,并剖析仲景治疗心悸的遣方用药特点。[结果]在八纲辨证理论基础上,可将心悸条文总结归纳为心阳亏虚、水饮内停、气血虚弱、气机不利、阴虚火旺五类证型,仲景治疗时常以温阳为重、化饮为先,温阳以桂枝配伍甘草为核心药对,化饮则茯苓为最佳选择;体现了合法而施、多法并用、三因制宜的杂合以治的学术特点;遵循形神同调,双心并治的治疗思想;根据患者证型特点,选取不同的特殊煎服法,重视煎服法的运用。[结论]临证治疗心悸时要明辨证型分类,借鉴学习仲景温阳化饮、杂合以治、形神同调、选取不同煎服法的证治特色,有助于进一步拓宽临床诊疗思路,对于临证治疗心悸有重要的启迪作用。

[Objective]To explore the therapeutic characteristics of ZHANG Zhongjing on palpitations in Treatise on Febrile and Miscellaneous Diseases.[Methods]Treatise on Febrile and Miscellaneous Diseases has a comprehensive discussion on palpitations.Through the systematic study of the provisions of palpitation in Treatise on Febrile and Miscellaneous Diseases and combined with the study of other ancient books,the author summarized the classification of palpitation in Treatise on Febrile and Miscellaneous Diseases,and analyzed the characteristics of ZHANG Zhongjing.[Results]On the basis of the eight principles of syndrome differentiation,the provisions of palpitation can be summarized as five categories:deficiency of heart Yang,internal retention of retained fluid,weakness of Qi and blood,disorder of Qi movement,and fire excess from Yin deficiency.To analyse the medication characteristics of ZHANG Zhongjing’s palpitation prescription,it was found that ZHANG Zhongjing’s treatment often focused on warming Yang and regulating retained fluid first.For warming Yang,Ramulus Cinnamomi combined with Glycyrrhiza uralensis Fisch.was the core drug pair,while Poria cocos was the best choice of regulating retained fluid,which reflected the academic characteristics of the combination of treatments application,multiple methods and three factors.Treatment idea followed the treatment of double hearts,simultaneous regulation of body and spirit.According to the characteristics of the patient’s syndrome,different special decoction methods were selected,and the application of decoction methods was emphasized.[Conclusion]In the temporary treatment of palpitation,it should be differentiated and learnt from the characteristics of warming Yang for resolving fluid retention,comprehensive treatment,simultaneous regulation of body and spirit and selection of different decoction methods,which can further broaden the clinical diagnosis and treatment ideas and has a great enlightening effect on the temporary treatment of palpitation.